Aspartate aminotransferase-to-platelet ratio predicts response to transarterial chemoembolisation and prognosis in hepatocellular carcinoma patients.

AIM: To evaluate the value of the aspartate aminotransferase-to-platelet ratio index (APRI) for hepatocellular carcinoma (HCC) patients who underwent transarterial chemoembolisation (TACE). MATERIALS AND METHODS: A total of 315 patients were enrolled, who were randomly divided into the training cohort (n=158) and the validation cohort (n=157). The optimal cut-off value of the APRI was determined using the X-tile software in the training cohort, and was validated in the validation cohort. Several serum-based markers, neutrophil-to-lymphocyte (N/L) and aspartate aminotransferase-to-alanine aminotransferase (AST/ALT) ratios were included to compare with the APRI. To predict individual survival rate, independent predictors were included to build a nomogram. RESULTS: Using the X-tile, a cut-off value of the APRI as 0.40 was yielded to distinguish patients with distinct outcomes in the training cohort, but failed for the N/L and ALT/AST ratios. In the training cohort, 66 patients with high APRI had poorer survival (p<0.001) than did 92 patients with low APRI. Using the same cut-off value of APRI, 61 patients with high APRI had poorer survival (p<0.001) than did 96 patients with low APRI in the validation cohort. Furthermore, a nomogram, including the APRI, TACE cycles, tumour size, and tumour number, was built based on the training cohort, and validated well in the validation cohort (concordance index [C-index] 0.713). CONCLUSION: The APRI is a promising marker to predict treatment response and outcome for HCC patients after TACE treatment.

[Characteristics and clinical significance of wideband tympanometry of otitis media with effusion in young children].

Objective: To study the characteristics of wideband tympanometry(WBT) and its application value in the diagnosis of otitis media with effusion(OME) in young children. Methods: We compared wideband acoustic energy absorbance(EA) under peak pressure in young children with OME(190 ears) and healthy control subjects(121 ears) from Ninth People's Hospital of Shanghai Jiaotong University School of Medicine between January 2018 and June 2020. Both groups were divided into three groups, 1-6 months, 7-36 months and 37-72 months. SPSS 20.0 statistical software was used to analyze and compare the EA parameters between OME children of different months and the control group. Receiver operating characteristic (ROC)curve was used to analyze the diagnostic value of WBT in young children with OME. Results: There were significant differences in EA among three OME groups from 500 Hz to 2 000 Hz(P<0.05).Compared with the control groups, EA of 1-6 m OME group decreased significantly below 4 000 Hz(P<0.05), EA of 7-36 m OME group decreased significantly at 545-1 600 Hz(P<0.05), EA of 37-72 m OME group decreased significantly above 545 Hz(P<0.05).ROC curve indicated that EA at 1 000 Hz had the greatest diagnostic value (AUC was 0.890), followed by 1 500 Hz and the range of 500-2 000 Hz (AUC was 0.883 and 0.881, respectively).EA at 1 000 Hz with a cutoff value of 0.55 had the best diagnostic sensitivity of 90.8%, which was higher than conventional tympanometry (85.8%). The maximum AUC (0.932) could be obtained by combining EA, peak pressure and admittance amplitude of 226 Hz tympanometry as predictors. Conclusions: EA is significantly decreased in young children with OME. Compared with the conventional single frequency tympanometry, WBT is more accurate in the diagnosis of OME in young children, and the prediction accuracy would be better if combined with 226 Hz tympanometry.

[Effects of bimodal intervention on the development of auditory and speech ability in infants with unilateral cochlear implantation].

Objective: To explore the effects of bimodal intervention on the development of auditory and speech ability in the infants with unilateral cochlear implantation(CI). Methods: Total 35 bilateral profound sensorineural hearing loss infants with unilateral CI, aged 0.7 to 2.8 years old, were selected. The subjects were divided into two groups: the group with unilateral CI(cochlear implant alone, n= 15), and the bimodal group with CI and contralateral fitting hearing aid(n= 20). Their auditory and speech abilities were estimated at the different time points after switch-on(the 0th, 0.5th, 1st, 3rd, 6th, 12th, 18th, and 24th month, respectively) using Infant Toddler-Meaningful Auditory Integration Scale(IT-MAIS), Meaningful Use of Speech Scale(MUSS), Categories of Auditory Performance(CAP), and Speech Intelligibility Rating(SIR) scores. Results: The IT-MAIS scores of bimodal group after switch-on were higher than unilateral CI group(the 0.5th, 1st, 3rd, 6th, 12th, and 18th month), the statistical significances were identified at the 0.5th, 1st, 3rd, 6th, and 12th month, respectively(P<0.05). The CAP scores of bimodal group before CI operation and after switch-on(the 0.5th, 1st, 3rd, 6th, 12th, 18th and 24th month)were higher than unilateral CI group, the statistical significances were seen at the 3rd, 6th, 12th, 18th and 24th month after switch-on(P<0.05). The MUSS scores of bimodal group after switch-on were higher than unilateral CI group(the 1st, 3rd, 6th, 12th, 18th and 24th month), the statistical significances were found at the 12th, 18th and 24th month, respectively(P<0.05). The SIR scores of bimodal group after switch-on were higher than unilateral CI group(the 3rd, 6th, 12th, 18th and 24th month), and significant differences appeared at the 12th, 18th and 24th month after switch-on(P<0.05). Conclusion: Bimodal intervention could be helpful to the development of auditory and speech ability of infants.

[Analysis of the effect of cochlear implant for the patients with acoustic neuroma in the only hearing ear].

OBJECTIVE: To discuss the method as well as effect of hearing restoration for patients with acoustic neuroma (AN) in the only hearing ear. METHODS: A retrospective study was conducted in three patients with AN in the only hearing ear. Ipsilateral cochlear implantation (CI) was performed in case 1 and contralateral CI was performed in case 2 without tumor resection. In case 3, CI was performed 6 months after tumor removal by the retrosigmoid approach. Dynamic changes in the audiological tests was recorded regularly. RESULTS: In case 1 and case 2, no matter which side CI was performed, pure tone average (PTA) was improved clearly, and speech discrimination score (SDS) was slightly increased. In case 3, hearing loss was observed after tumor removal. Simultaneous bilateral CI after 12 months was performed in this case. PTA on both sides was largely lower than that before CI, and SDS was slightly improved. With bilateral CI, SDS was improved, especially in noise, compared with unilateral CI on either side. CONCLUSIONS: For patients with AN in the only hearing ear, CI can significantly improve PTA, and SDS can be slightly increased. Bilateral CI should improve the outcome of hearing restoration compared with unilateral CI.

The Internet and the future of psychiatry.

OBJECTIVE: The Internet is a rapidly growing communications resource that is beginning to have an impact on medicine, and it is anticipated that the Internet will soon have a major effect on psychiatry. It is essential for psychiatrists to have a conceptual framework for understanding the many aspects of the Internet. METHOD: Using a four-layer model, the authors describe the components of the Internet and how these work together to establish communication. They discuss some of the practical implications of the model, potential future applications of the Internet, and some of the challenges its use will create. RESULTS: In the Internet model described, the bottom three layers involve hardware and modes of information transmission; the fourth layer is human interaction. The Internet has great potential in psychiatric education, clinical care, research, and administration, but major adjustments in individual and organizational expectations and responses will be needed. These changes relate to the speed, dispersion, volume, privacy, and permanence of communication. CONCLUSIONS: The growth of the Internet and related information technologies is inevitable and has diverse technical and social implications. As psychiatrists, we must remain effective communicators of information and adjust to a changing world with new roles and skills that will permit us to best serve our professional mission.

Apoptosis mediators fasL and TRAIL are upregulated in peripheral blood mononuclear cells in MS.

OBJECTIVE: To investigate the expression of apoptosis-inducing ligand and receptor molecules in patients with MS. BACKGROUND: Dysregulation of apoptosis may induce autoimmune conditions, possibly through inadequate termination of immune responses, and could be of importance for pathogenesis of MS. METHODS: Messenger RNA (mRNA) levels of two apoptosis-related members of the tumor necrosis factor (TNF) receptor family, Fas and TNF-related apoptosis-inducing ligand (TRAIL) receptor 2 (TRAIL-R2), and their ligands, Fas ligand (FasL) and TRAIL, were quantified by competitive reverse transcription PCR in unstimulated peripheral blood mononuclear cells in 47 untreated patients with MS and 46 control subjects. RESULTS: The expression of FasL was increased in patients with MS compared with healthy control subjects. Analysis of clinical subgroups revealed that the increase was marked in relapsing-remitting MS, being especially high in remission (p = 0.0002), but less so in chronic progressive MS (p = 0.14). Compared with healthy control subjects, TRAIL mRNA levels were also upregulated in patients with MS (p = 0.0001) but did not differ between clinical subgroups. The expression of TRAIL-R2 was slightly elevated in patients with MS (p = 0.02) whereas the expression of Fas was similar in patients and control subjects. The ratio of expression levels for two isoforms of TRAIL-R2, TRICK2a and TRICK2b, in patients with MS differed from healthy control subjects (p = 0.04). CONCLUSIONS: There was increased expression of both FasL and TRAIL in peripheral blood lymphocytes. It remains to be determined whether this increased expression represents a disease-promoting autoimmune process or is merely the effect of a secondary compensatory mechanism that downregulates the inflammatory response.

Structure-activity relationships of anthraquinones as inhibitors of 7-ethoxycoumarin O-deethylase and mutagenicity of 2-amino-3-methylimidazo[4,5-f]quinoline.

The antimutagenicity of 17 natural and synthetic anthraquinones was determined using Salmonella typhimurium TA98 against 2-amino-3-methylimidazo[4,5-f]quinoline (IQ) in the presence of Aroclor 1254-induced rat hepatic S9. In general, the relationship between the chemical structures of anthraquinones and their antimutagenicity was found to contain one or more of the following features: (i) C9 carbonyl group, (ii) hydroxyl group at C1 and C4, (iii) C2 ethyl group, and (iv) C3 methyl group. The inhibitory effect of anthraquinones on 7-ethoxycoumarin O-deethylase (ECD) of Aroclor, 1254-induced hepatic microsomes was also examined. In addition, we studied the effect of anthraquinones on the metabolism of IQ by Aroclor 1254-induced microsomes using high-performance liquid chromatography. The antimutagenicity correlated with the inhibition of cytochrome P-450IA2-linked ECD activity in hepatic microsomes, and with the inhibition of N-hydroxy-IQ formation of IQ metabolism by hepatic microsomes. Moreover, we also examined the antimutagenicity of anthraquinones against synthetic N-hydroxy-IQ. Quinizarin and anthraflavic acid were shown to have more effect on the direct mutagenicity of N-hydroxy-IQ than that of the anthraquinones tested. This might explain why both anthraquinones showed higher antimutagenicity; although they inhibited ECD less. These results suggest that there exist at least two mechanisms of action in modifying roles of anthraquinones on the mutagenicity of IQ: (i) mediation through interaction with microsomal activating enzymes to inhibit the major active metabolite of N-hydroxy-IQ formation and (ii) direct interaction with the proximate metabolite of IQ, N-hydroxy-IQ, to block its attack on DNA.

Introduction: beyond presence.

Presence is a concept arising from the use of sophisticated remote control devices and virtual reality equipment. It refers to the user's sense of being at a remote or virtual environment. This introduction briefly describes some of how the research on this concept developed, as well as some of the issues of how it is defined and measured. It also suggests that earlier research has been biased towards analyzing how attributes of technology or the environment impacts the individual rather than examining how individual psychological, cognitive, and attentional variables affect our virtual interactions. Current research is exploring new models and issues in the presence arena, as illustrated by this set of articles in this issue of CyberPsychology and Behavior. The development of these directions will hopefully expand our thinking about "virtual presence" to that of "virtual experience."

Mental health implications for presence.

"Presence," as discussed in the virtual reality (VR) literature, is the sense of truly being in a virtual place. This literature explores many aspects of presence including interactive and environmental factors. This exploration has generally ignored the impact of the individual's mental status on the experience of presence. Mental disorders such as depression, anxiety, and psychosis may each define a population with specific tendencies to respond to VR in particular ways. To fully understand the experience of presence in virtual environments, we must understand more about the impact of different mental states on presence. Such an understanding will improve our insight into the construct of presence, assist in improved design of virtual environments, and better inform us about how virtual environments can be applied in the treatment of emotional disorders.

The potential relevance of attachment theory in assessing relatedness with virtual humans.

Primary efforts to create virtual humans have been in the production of computer generated ergonomically correct objects that look like humans. Although there has been concern with essential human factors, absent are the metrics of human relatedness, or the ability to assess the degree to which a virtual human elicits human emotions. We discuss the potential application of attachment theory as a context for the development of such an assessment paradigm, and specifically the application of the Ainsworth Strange Situation in the evaluation of a "Virtual Mom". Virtual relatedness fidelity is discussed as a macrometric to define relatedness that would occur with virtual humans. Potential lessons learned are discussed as they apply to the selection of those to develop the model, and its impact on the introduction of virtual humans into clinical psychiatry and psychology.

Current limitations into the application of virtual reality to mental health research.

Virtual Reality (VR) environments have significant potential as a tool in mental health research, but are limited by technical factors and by mental health research factors. Technical difficulties include cost and complexity of virtual environment creation. Mental health research difficulties include current inadequacy of standards to specify needed details for virtual environment design. Technical difficulties are disappearing with technological advances, but the mental health research difficulties will take a concerted effort to overcome. Some of this effort will need to be directed at the formation of collaborative projects and standards for how such collaborations should proceed.

Presence as an emotional experience.

Presence or the sense of "being there" has been discussed in the literature as an essential, defining aspect of Virtual Reality (VR). The VR literature includes definitions rooted in behavioral response, signal detection theory, and philosophy, but has generally ignored the emotional aspects of experience. The purpose of this paper is to reexamine the concept of presence in terms of people's emotional engagement with reality and their environment. Emotions are an essential part of how people experience the world. Any theory of presence must take emotional factors into account. This thesis has implications about how research should be conducted to further our understanding of presence. Validated psychological techniques for assessing emotions by subjective report, behavioral observations, and facial analysis can all be applied to increase our understanding of virtual presence. Further understanding of the interaction between presence and emotional state will improve our understanding of the construct of presence as well as better inform us about how virtual environments can be applied in creating emotional effects or treating emotional disorders.

Digital motion phenomenology of depression.

The long-term objective of our project is to use motion capture technology to identify and characterize body alterations in motion associated with depression that have not been previously recognized or characterizable. These motion phenomena will be studied to determine their utility in the nosology and subtyping of depression. Quantitatively, they may have a significant impact in the areas of research, education and the clinical management of depression; and allow the creation of "virtual humans" which manifest depressive digital motion phenomena that can be used to train researchers, trainees and clinicians.

Comparing virtual and real worlds for acrophobia treatment.

Traditional treatment of phobias involves a process of gradual exposure to the feared object. Virtual Reality (VR) environments have been used to effectively treat phobias by simulating feared situations, yet these initial studies have been performed by comparing the effect to no-treatment conditions. We are in the process of comparing VR exposure treatment to "gold-standard" in-vivo exposure treatment by replicating an actual in-vivo exposure area in a VR model. The process of controlling for differences between the two environments highlights a general procedure of selecting elements in virtual environment design, targeted towards producing particular emotional effects. It also raises questions about the necessity for highly realistic simulation in VR phobia treatment.

The influence of simultaneous mechanical and thermal loads on the stress distribution in molars with amalgam restorations.

A finite element analysis (FEA) of a mandibular molar restored with Class II amalgam restoration was conducted to determine the stress distribution which results from a superposition of simultaneous mechanical and thermal loading. A fully crossed three-level four-factor experimental design was used to evaluate the relative influence of crown temperature, time of thermal loading, occlusal force, and cavo-surface margin adhesion on the stress distribution. It was found that occlusal force and temperature had significant influence on the stress distribution and particularly on the maximum principal stress. Over the range in oral conditions considered, thermal loading contributed for over 35% of the stress within the restored molar subjected to simultaneous mechanical and thermal loads. Furthermore, thermal loading had significant effects on the magnitude of normal stress that develops parallel to the pulpal floor. Although marginal bonding of amalgam reduces the stress resulting from occlusal forces, thermal loading promotes the development of significant interfacial shear stresses along the bonded margin. Stresses related to the thermal component of loading concentrate near the pulpal floor and lingual surface margin, the site most prominent in cusp fracture. Hence, results from this study clearly indicate that an evaluation of new dental materials and/or restorative designs should consider the effects from a superposition of simultaneous mechanical and thermal loads on fracture resistance.